Sometimes the best solutions are right before our eyes
Since the 1960s it has been known that certain procedures — such as hysterectomies and colorectal operations — run a high risk for infections, and that if surgeons use prophylactic antibiotics during these surgeries, infection can be avoided.
Now, the Health System hospitals operating rooms are using electronic whiteboards to inform OR medical staff of each patient’s antibiotic needs.
“We had already put up these giant screens in the ORs to show the patient’s name and procedure, and it occurred to us that we could put the screens to even greater use by adding the specific antibiotic individual patients should receive based on the procedure they are having,” says Mark Pearlman, M.D., professor of obstetrics and gynecology, and head of the OB/Gyn portion of the project.
Of course, it wasn’t that simple. Hundreds of antibiotics and their alternatives (if the patient has an allergy)— and hundreds of different procedures — require a lot of information and a lot of computer code. And the input had to reflect guidelines from the federal Centers for Medicare and Medicaid Services (CMS) Surgical Care Improvement Project (SCIP). In addition, SCIP measures are linked to the CMS Value Based Purchasing Program.
But the project got off the ground—and has been extremely successful—thanks to a team that included surgeons, pharmacists, anesthesiologists, nurses and Hospital Applications System Analyst Steve Harrington, who plunged in and did all the programming.
“Now if somebody is having a hysterectomy, for example, the whiteboard will show their correct antibiotic, even if they have an allergy, which also shows up on the electronic whiteboard and is pulled directly from their medical record,” Pearlman says.
The project was a year in the making. The first phase — OB/Gyn — went live July 29.
“Previously, our performance in OB/Gyn was at 95 percent. Now it is at 99 percent and would be even higher except that sometimes the drug actually was correct but the patient was allergic to everything. Now, we almost never have failures,” Pearlman says.
Pearlman said he never doubted the commitment it would take to get this project done. “Our staff are tremendous, and our surgeons were not only compliant but in many cases had actually set the national standard for care in the first place, so were well acquainted with how necessary this is,” he says.
“The addition of the appropriate antibiotics for each case to the OR whiteboard essentially centralized all the necessary information for an appropriate and robust “time out” prior to every case,” says Sandra Wong, M.D., associate professor of surgery, and head of the General Surgery portion of the project.
“Instead of asking if antibiotics were given prior to incision, the question evolves into asking if the appropriate antibiotics were given, with a reference to the appropriate antibiotics (as well as alternatives for patients with allergies) displayed for every team member to see,” she says.
“We have been working hard to get to 100 percent compliance with SCIP-2 (the Surgical Care Improvement Project measure that deals with appropriate antibiotic selection) for colon resections,” she says. The colorectal phase began in November 2013 so it is too early to report measure results.
“With these boards in place when SCIP measures change, we’ll be ready. We’ll be a lot more nimble. We can change,” Pearlman says. “And we do hope to roll this out to other areas.”